Ординатура / Офтальмология / Английские материалы / Fixing My Gaze_Barry, Sacks_2010
.pdffriends. Although we were not told why we were each assigned to a particular classroom, the groupings were obvious to me and all of my schoolmates. One class was for the above-average students, one for the average learners, one for the below-average pupils, and one for the children with “special problems.” On the first day of third grade, I was placed in the above-average class but survived there for only one week. A mistake had been made. My score on the standardized test from the previous year indicated that I was supposed to be in Mrs. Danner’s special-problems class.
The assistant principal came into the classroom and asked me to stand up. She instructed me to leave the classroom and asked a boy to drag my desk behind me as I walked down to Mrs. Danner’s room. The desk made an awful noise as it scraped along the floor. I felt humiliated and shamed by being made the center of so much attention.
When I got home from school, I was very upset, and my parents arranged a meeting the next day with Mrs. Bell, my teacher from the previous year. I had spent the preceding year in great fear of Mrs. Bell, for she had a habit of tipping over a student’s desk if the contents were not kept neat and organized. My parents learned, however, that Mrs. Bell was my great advocate. She had argued fiercely with the principal over my classroom placement. She suggested to him that having my eyes rearranged in their sockets three times in five years had interfered with my reading skills.
After talking with Mrs. Bell, my parents met with the principal. But he insisted that the tests were accurate and objective. My aptitude, he told them, was well below average, and I had been wisely moved into Mrs. Danner’s class. My vision was not considered to be a factor.
My mother panicked. The most law-abiding individual on earth, she snuck into the school’s office after hours and stole a copy of the achievement test on which I had performed so poorly. At home, she took me down to the basement, told me not to breathe a word to my brother or sister, and gave me the test. In the quiet, relaxed atmosphere of my home, I did much better. Again, my mother met and argued with the principal, but she couldn’t admit to him that she had snuck into his office and absconded with the test. I remained in Mrs. Danner’s class.
I hated all of this fuss about my abilities. I was embarrassed around the kids in my neighborhood because I assumed that they all thought I was dumb. At school, I said nothing, never raised my hand to answer the teacher’s questions, and essentially tried to disappear. But I did gain something positive from this experience. I learned that my mother, normally so gentle and soft-spoken, would not only fight but break the rules for me, and she questioned the school authorities—not my intelligence.
Mrs. Danner was unusually calm, patient, and steady, but the children in her classroom were not. There was something wrong with all of us. Some of my classmates
had physical problems, most had trouble paying attention, and several were completely disruptive. I made one good friend in the class, a boy name Scott, who had suffered from polio and walked with a limp. Years later, when we were in high school, Scott got into a motorcycle accident and injured his good leg. The high school principal got on the public address system, told the school about Scott’s accident, suggested that we all send “get well” cards, and then gave a speech about reckless behavior. I remember my anger building as I listened to him preach. I believed that Scott’s “reckless” behavior resulted from the way he had been treated since the first days of school, from growing up labeled as “different” and being regarded as a “failure.” As I listened to the principal, I reminded myself never to be too quick to judge other people.
My mother taught me how to read when the school gave up on me. She read with me and to me constantly. Often, she would leave a new book on my bed that I would discover when I returned home from school. I was very shy and felt happiest when exploring the countryside, categorizing wildflowers, trees, and rocks. My mother would leave me books about nature and animals. When I finally discovered Walter Farley’s Black Stallion series, I was hooked and began to read for pleasure.
By fifth grade, I had become a competent, if slow, reader. I was finally transitioned out of the special-problems class and into a regular classroom. I was a fanatic student, compulsively checking my answers again and again in the
hopes that my hard work and discipline would hide my tested lack of intelligence. There was one reading exercise, however, that I simply could not do. My teacher called it “controlled reading,” and it involved reading a story while the words moved by on a screen in the front of the classroom. After the text rolled by, I had to answer questions in a workbook relating to the story. I could not follow the moving words and was sure that I would be sent out of the classroom, desk and all, back to the specialproblems class. I quickly discovered, however, that the answers to the questions were printed on the back page of the slim workbook. If I pressed down on the page with the questions, I could see through to the back page. It was the only way I could answer the questions correctly, and it was the only time I ever cheated in school.
Common experience tells us that our vision plays a large part in our ability to read and do well in school. Yet, many school administrators and physicians have long questioned the connection between vision and learning. Most of us consider “perfect” vision to mean 20/20 eyesight as measured by identifying the letters on the Snellen eye chart —commonly recognized as the chart with the big letter E on top. Yet, good eyesight (or acuity) and good vision are not the same thing. We need more than 20/20 eyesight to read a book. When we read, we view letters and words positioned about sixteen inches from our face, not twenty feet away, and we must be able to sustain close viewing for long periods. We look at the letters with two eyes, not just
with one as in an eye exam, and we have to move our eyes across the line of words in a coordinated manner. Finally and most importantly, we have to extract meaning from the words. All of these processes are involved in good vision and affect our ability to learn.
Although the exact role of vision in learning is a subject of intense debate, many scientific studies support a connection between vision and reading. For example, one paper published in 2007 examined the visual skills of 461 high school students who read at two or more levels below the established level for their grade. Of these students, 80 percent had eyesight of 20/40 or better when looking at an eye chart placed twenty feet away. However, at least onefifth of these students had trouble focusing on the text for sustained periods. What’s more, the majority of the students fell below normal standards in their ability to converge and diverge their eyes for stereovision. Additional papers have demonstrated a correlation between reading skill level and the ability to see with stereopsis.
Why would there be a correlation between stereopsis and reading? After all, you can read with only one eye; when you read, you are looking at a flat page, not a threedimensional object, and you do not need to judge depth while reading. But poor or absent stereopsis indicates difficulty merging the information from the two eyes. Instead, that information may be conflicting—as was my situation. I had 20/20 eyesight with both eyes and no
problem passing a standard school vision screening. Yet, my vision was abnormal because I did not use my two eyes together. The uncorrelated information from my eyes greatly disrupted my ability to read.
For years, scientific research done on eye movements during reading monitored the movements of only one eye. It was assumed that the two eyes moved in concert, so observing the movement of one eye was sufficient to know what both were doing. But recent experiments examining the movement of both eyes together during reading have yielded some important surprises. For most of us, our eyes do not always point to the exact same place on the page when we’re reading. For about 50 percent of the time, the right eye is aimed about one to two letters to the right of the letter seen by the left eye. This doesn’t present a problem to the reader because the images from the eyes are merged in the brain. The information is combined in a cooperative fashion.
What happens, however, if the two eyes register conflicting information? Since I was cross-eyed, I crossfixated. When I was learning to read, my right eye saw letters located to the left of the letters that I saw with my left eye. I didn’t merge images from the two eyes but rapidly alternated between my leftand right-eye views. Although I am not dyslexic, I distinctly remember being in first grade and trying to figure out whether the word I was reading was “saw” or “was.” Pinpointing the exact location of letters on a page was very difficult.
By the time I reached fifth grade, I had unconsciously found a way to read books comfortably (even if I could not do the controlled-reading task.) However, I did not discover how I used my eyes for reading until I was an adult and underwent an eye exam with a developmental optometrist. When I looked at the words with my right eye, my left eye turned in, or crossed, by 15º. If I read with my left eye, the reverse happened. The fact that I turned in my eye by 15º reveals how I eliminated the interference between the two eyes, for our “blind spot” is located 15º from the center of the retina. In this region, where the optic nerve leaves the retina for rest of the brain (figure 1.2), there are no lightsensing cells. When I read with my right eye, the image of the word fell on the fovea of my right eye and on the blind spot of my turned left eye. The reverse held true when I read with my left eye. Unconsciously, I had found an effective way to eliminate the conflicting image from the nonfixating eye.
Examples abound of children who have visual problems misdiagnosed as learning disorders. Indeed, hearing Michelle Dore’s story about her son, Eric, reminded me of how common it is to misdiagnose youngsters with vision problems. Michelle’s son was determined in kindergarten to have attention deficit hyperactivity disorder (ADHD). Eric’s teachers told Michelle that he was smart and could be a good student if he would only settle down. So, Eric was put on a host of drugs intended to control his unruly behavior. His parents even enrolled him in a pilot study for a new type of medication, but the drug made Eric feel like a
zombie. When, in school, Eric was slow at copying the information from the board, his teacher assumed he was not paying attention and sent him to the time-out room as punishment. Of course, this punishment only made it harder for Eric to keep up in class. When Michelle saw the timeout room, actually a windowless closet, she took him out of that school and enrolled him in another in her constant search for an environment in which he could succeed.
Eric was not an avid reader, but he liked the Harry Potter books because the print was large with more white spaces between the words. When Michelle observed this, she insisted that the school provide Eric with tests in which the words were printed in larger letters, and gradually his performance in school improved. About this time, Eric developed a passion for hockey, a passion he shared with his dad. His father coached him; he practiced like mad, becoming talented enough to make one of the better teams in the region. Even so, Eric always seemed to be a split second behind in his moves, and he often endured bullying by his peers.
One evening at dinner, when Eric was in his teens, Michelle noticed that one of Eric’s eyes would turn out intermittently. Since this happened when Eric was looking closely at an object with his eyes cast downward, she had never observed the eye turn before. She took him to the pediatrician, who noticed nothing wrong. But Eric’s mother still suspected that something was holding him back.
When, some time later, Michelle saw a flyer advertising a new clinic to treat ADHD, she took Eric to it. Among the tests administered at the clinic were several that examined eye coordination. The tests revealed that he had trouble moving his eyes together when reading. Encouraged by this new piece of information, Michelle took Eric to see a developmental optometrist.
After all these years of doctor’s visits and school tests, Michelle finally learned that Eric’s difficulties resulted from a visual condition called convergence insufficiency, a common but often undiagnosed cause of reading troubles. Eric aligned his eyes appropriately for far viewing but not for near. When an object was brought close to his face, Eric abandoned stereoviewing. Instead, he looked at the object with just one eye and allowed the other to wander out just like he had at dinner that night. If he couldn’t converge his eyes for near viewing, Michelle wondered, how had her son managed to read a book in school or judge the distance of other hockey players on the ice? How had he followed an approaching puck or caught a pass? As Michelle thought about her son’s visual challenges, she felt a renewed appreciation for his determination and perseverance.
As Michelle discovered, convergence insufficiency is not easy to spot without careful testing. What’s more, most children don’t realize that they have a vision problem. They don’t know that the words shouldn’t jump around on the page when they read. They don’t realize that the letters shouldn’t appear doubled or blurred. Of course, these
unrecognized difficulties with reading and the subsequent troubles with schoolwork can lead, as they did in Eric’s case, to behavioral problems. Since standard school vision screenings do not pick up this vision problem, children with this condition who appear restless in school and are poor learners may be labeled with ADHD or other disorders.
According to a recent National Eye Institute study of 221 children, the most effective treatment for Eric’s condition is a combination of office-based and home-based vision therapy. After five months of vision therapy with a developmental optometrist, Eric’s reading and grades improved, and he was able to realize his dream of competing in a highly competitive hockey league. With renewed confidence, Eric entered college and became one of the top students in his class.
Every person with a binocular vision disorder copes slightly differently. I found a way to adapt my vision for reading by fifth grade, but my vision led to other challenges throughout school. When I was in eighth grade, all of the boys had to take a shop course, and all of the girls had to learn to sew. I absolutely loathed sewing. When I was instructed to sew by hand, I found it extremely tedious and tiring because it was difficult to keep my gaze on the needle as I moved it in and out of a piece of cloth. Using the electric sewing machine was even worse. I couldn’t follow the rapidly oscillating sewing machine needle in order to guide a piece of fabric underneath it. To my dismay, I was supposed to make a dress and then model it in a fashion